The First Gynecological Exam

Gynecology is health care for the female body, focusing on the sexual and reproductive organs. Proper gynecological care helps prevent many undesired cancers, diseases and other illnesses by allowing for early detection. Early detection is essential for effective preventative measures and treatment.

Regardless of your age, marital status, sexuality or level of sexual activity, gynecological care is important. Listen to your body when it signals that something may be wrong. Don't hesitate to approach a health care professional with any questions regarding your body or changes it might be going through. It is important to choose a doctor you'd be comfortable speaking with confidentially and asking questions of a personal nature that might be of concern to you.

Women should start seeing their gynecologist at least once every year when they turn 18 years old, or when they start being sexually active.

You may need to have checkups even more often if you have (1):

Plans to become pregnant

A sexually transmitted disease (STD) or a sex partner with an STD

A history of sexual health problems

A sexually-related illness

A mother or sister who developed breast cancer before menopause

A history of abnormal Pap test results

A breast lump

Additionally, women and girls of any age need to visit their gynecologist if they notice irregularities in their breasts, genitalia, menstrual cycles, or if they become pregnant. You should consult your clinician if you have any of the following symptoms (2):

The first visit to the gynecologist can be scary, but knowing what to expect can help... The exam consists of:

Talking about your personal, family, sexual, and medical history

Laboratory tests and screening for STDs and other conditions (at your own or your clinician's request). This includes both blood and urine samples (3).

Counseling

A pelvic exam

A breast exam

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Preparation
Preparing for the visit may help you relax and get the most out of your appointment.

1. Make sure that you will not have your period during your scheduled exam. Bleeding can affect the accuracy of the results and make it difficult for the clinician to perform some of the tests. You should inform the examiner before you come in for the exam if you think you might have your period during that time -- you might be asked to reschedule your appointment.

2. Don't douche for at least 24 hours before the appointment. Don't use any other vaginal preparation, either. They can mask many vaginal conditions (4).

3. Since the first part of the exam consists mainly of conversation, you should know what you want to discuss before going in to the exam room. Make a list of all the concerns and general questions you want to discuss, don't forget to include problems you might be having. It's generally a good idea to have these questions written down going into the exam because they are easy to forget when you are nervous. Include questions about (5):

Vaginal discharge

Spotting between periods

Heavier than usual flow

Bleeding after sex

Pelvic pain or other problems

Any noticeable irregularities regarding your period

Unusual pain

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The ExamPersonal History (6)
Before you are physically examined, you may be asked to fill out a questionnaire, or your doctor or nurse may ask you these questions:

When was your last period?

How often do you have periods?

How long do they last?

Do you have any bleeding between periods?

Do you feel any pain when having sex?

Is there any bleeding after sex?

Do you have any unusual genital pain, itching, or discharge?

Do you have any other medical conditions?

What medical problems do other members of your family have?

Are you using birth control?

Do you suspect you are pregnant?

Are you trying to become pregnant?

What method do you use to prevent sexually transmitted infections?

You will be asked about past illnesses, allergies, surgery, and pregnancy. You may be asked if you smoke, how much you smoke, or if you drink alcohol or use other drugs. You may also be asked if you have problems holding your urine.
Your clinician will review your contraceptive needs. If you are using birth control, you will be asked if you've experienced any side effects (7).

Use this opportunity to discuss contraception with your doctor, as your choices for appropriate birth control change throughout your life. To decide which one to use now, consider how well each method will work for you (8):

How well will it fit into your lifestyle?

How effective will it be?

How safe will it be?

How affordable will it be?

How reversible will it be?

Will it protect against sexually transmitted infections?

Your clinician can provide you with the information you need to make the best choice for you.

It is very important to be frank and honest about your sex life. One out of four women have an STD in her lifetime. STDs can cause sterility, birth defects, and cancer. Some can cause death. Great harm can be done even when there are no symptoms; very often, women have no symptoms. It's very important to let your clinician know whether or not you are at risk for STDs (9).

Previous pregnancies or STDs may be detected during the exam. However, your clinician won't be able to tell if you've had vaginal, oral, or anal intercourse, how many partners you have, or if you masturbate. So be sure to talk with your clinician about any sexual health risks you may be taking.

Don't let embarrassment become a health risk! Be precise about your sexual health risks and questions about your sex life. Being clear will help your clinician suggest the best solutions (10).

The Urine Sample
Pregnancy, kidney infections, diabetes, and some other diseases can be detected by testing your urine. You most probably will be asked to give a urine sample.

Since your bladder is located in front of your cervix and uterus link to dictionary, emptying your bladder before the pelvic exam may help you relax and make the exam a bit more comfortable for you, while also making it easier for the examiner.

The Breast Exam
For the remainder of the physical exam, you will need to be fully unclothed. You will be provided with an examination gown, a drape sheet, or both. The examiner will ask you to lie back on the exam table. The clinician will examine your breasts with his/her hands for any irregularities such as lumps, discharge, and thickening. To make you a bit more comfortable, the examiner might ask you some more questions during this part of the exam. This would be a good time to ask your examiner to teach you how to do a Breast Self Exam (BSE) which should be done at least once every month. The best time for a BSE is just after your period, when your breasts are not swollen or tender (11). Since most breast lumps are discovered by a woman or her sex partner it is important to pay special attention to your BSE. Most lumps are not cancerous, but should not be taken lightly; report anything unusual to your clinician as soon as possible.

The Pelvic Exam
Once the breast exam is over, the examiner will need for you to put your knees up. You will either rest the heels of your feet on stirrups or your knees in knee rests. Then you will be asked to slide your hips to the edge of the table. This provides the examiner with the best angle for the pelvic exam and will also be the position of least discomfort for you.

You will need to let your knees spread wide apart and relax as much as possible. This may seem difficult, but it gets easier as you get used to visiting your gynecologist. Relaxation of the abdominal and vaginal muscles will make the exam more comfortable for you and provide best results. You do not need to worry about being exposed, you will be provided with a drape sheet, or you can ask the examiner for an extra one. The examiners are very respectful of your privacy and are understanding of the situation.

You'll feel less tense if you (12):

Breathe slowly and deeply with your mouth open.

Let your stomach muscles go soft.

Relax your shoulders.

Relax the muscles between your legs.

Ask the clinician to describe what's being done as it's happening.

If your examiner or gynecologist is a man, you should request having another woman in the room. Her presence may help you feel more relaxed. She may hold your hand or just talk to you to ease your tension. Ask in advance if you want to see what's going on and/or have your reproductive organs identified for you. A mirror may be positioned so you can see (13).

Usually, the exam lasts just a few minutes.

The External Genital Exam (14)
The examiner visually examines the soft folds of the vulva and the opening of the vagina to check for signs of redness, irritation, discharge, cysts, genital warts, or other conditions.

The Speculum Exam (15)
The clinician inserts a sterile metal or plastic speculum into the vagina. The speculum is opened to separate the walls of the vagina, which normally are closed and touch each other. It holds the walls apart so that the cervix can be seen.

You may feel some degree of pressure or mild discomfort when the speculum is inserted and opened. You will likely feel more discomfort if you are tense or if your vagina or pelvic organs are infected. The position of your cervix or uterus may affect your comfort as well. If a metal speculum is used, you may feel the chill of the metal. Most clinicians lubricate the speculum and warm it to body temperature for more comfort, but you should talk with your clinician about any discomfort you feel.

Once the speculum is in place, the clinician checks for any irritation, growth, or abnormal discharge from the cervix. Tests for gonorrhea, human papilloma virus (HPV), chlamydia, or other STDs may be taken by collecting cervical mucus on a cotton swab. It is possible to have many of these STDs without symptoms. The tests may not be done unless you have a concern about infections and ask for STD testing. Be sure to talk with your clinician if you have symptoms or concerns about your sexual partner(s).

The Pap Smear
The clinician will take a smear for a Pap test. Usually a small spatula or tiny brush is used to gently collect cells from the cervix. The cells are tested for the presence of precancerous or cancerous cells. You may have some staining or bleeding after the sample is taken (16).

As the clinician removes the speculum, the vaginal walls are checked for redness, irritation, injury, and any other problems (17).

Pap tests can detect (18):

The presence of abnormal growth in the cervix

Infections and inflammations of the cervix

Thinning of the vaginal lining from lack of estrogen.

Interpreting Pap Tests: (19)
Cytologists are very careful about interpreting Pap tests. They don't want to overlook any abnormality. They are also aware that failure to detect early cancers can lead to serious and even deadly consequences. Their caution may lead them to label test results as "ASCUS" (atypical cells of unknown significance).

If your test results are labeled ASCUS, your clinician is required to schedule more frequent testing that may include colposcopy and biopsy. Fewer cancers are overlooked with these precautions. But waiting while more tests are done can lead to more anxiety, as well as expense. It is reassuring that all precautions improve the chance of finding abnormal growths before it is too late. A number of different treatments may be prescribed if you have abnormal results.

Be sure to complete the prescribed treatment and repeat the test as advised if noncancerous abnormalities and infections are found.

You will need treatment and follow up if early precancerous or suspicious growths are found.

You might be advised to:

Repeat the test in a few weeks.

Treat the cervix with antibiotic cream.

Have a colposcopy and biopsy.

Moderate to severe precancerous growths require colposcopy and biopsy. They usually need to be removed with cryotherapy, laser surgery, or electrocautory.

Pap tests need to be repeated if there is too much blood present for an accurate reading or if there is not enough tissue to be examined.

Remember:

Most abnormalities that are detected are not cancerous.

Early treatment of precancerous growths can prevent cancer from developing.

Follow-up examinations are necessary if an abnormal condition is found.

The Bimanual Exam
With a gloved hand, the examiner will insert one or two lubricated fingers into the vagina while the other hand presses down on the lower abdomen. This is done so that the internal organs of the pelvis can be felt between the two hands.

This part of the exam detects for (20):

Size, shape, and position of the uterus

An enlarged uterus, which could indicate a pregnancy or fibroids

Tenderness or pain, which might indicate infection

Swelling of the fallopian tubes

Enlarged ovaries, cysts, or tumors.

The bimanual part of the exam causes a sensation of pressure. You may find it somewhat uncomfortable. Deep breathing through the mouth helps. If you feel pain, tell the clinician, it?s important that you voice any pain you might experience during the examination (21).

Rectovaginal Exam
One last part of the exam is the insertion of the examiner's gloved finger into the rectum. This rectovaginal exam detects for possible tumors on the uterus, vagina, and rectum, while checking the condition of the muscles that separate the rectum from the vagina. Some clinicians complete the rectovaginal exam with one finger in the anus and another in the vagina for a more thorough examination of the tissue in between. This is definitely not one of the most comfortable experiences, but our health is worth this mild discomfort. During this procedure, you may feel as though you need to have a bowel movement. This is normal and lasts only a few seconds (22).

After the Physical Exam (23)
This is a time for further consultation with your clinician. You will discuss the results of your exam, arrange for any follow up or consultation that may be needed, and ask any further questions you may have. This is another opportunity to discuss your concerns about sex and sexuality, birth control, pregnancy, abortion, STDs, loss of urine, inherited disorders, infertility, cancer signals, breast self-exams, and menopause. Don't let embarrassment become a health risk. Speak up!

If the lab tests indicate anything unusual, you will be contacted when the results are completed. Pregnancy test results are usually ready during your visit. Other test results may take three to 14 days. Your clinician will tell you how long you'll have to wait. Be sure your clinician has your current address and phone number.

It is also important to schedule regular appointments with your gynecologist in order to ensure your future good health.
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